During treatment of heart failure, differentiation is made between therapy for acute heart failure and for chronic heart failure.
Acute heart failure refers to a functional failure of the heart which results in reduced perfusion of the organs with blood. The most common cause of severe acute heart failure is myocardial ischemia, which can occur in the context of an acute myocardial infarction. Other causes of acute heart failure can be acute myocarditis, myocardial tamponade, acute decompensation with existing chonical heart failure due to chronical valve defects, or other more infrequent causes (e.g. intracardiac tumors).
Aside from causal treatment of acute heart failure, pharmacologic support with inotropic medications is often necessary to stabilize the circulation. If the circulatory status is not stabilized despite removal of the cause of heart failure and maximum medication-based support, the use of a ventricular assist device is recommended. Selecting the right system will depend on the condition of the patient, the estimated length of use, and the system's local availability. If the cause of heart failure leads to the assumption that the heart will not recover or that it will require a system over a long period of time, there will be an indication for implantation of a long-term ventricular assist device.
The aim of chronic heart failure therapy is to stop the progression of the disease and thereby significantly reduce the number of hospital stays as well as the mortality rate. It is important to identify the causes of such heart failure, and to treat the underlying condition to the greatest possible extent. Different medications are now available for the pharmacological treatment of chronic heart failure. Some improve demonstrably the chances of survival (beta blockers, ACE inhibitors, AT2 receptor blockers and aldosterone antagonists) while others, in turn, simply alleviate the symptoms (diuretics). In addition to pharmacologic support for heart failure, which is of primary importance, there are also a variety of invasive therapies options. Surgical therapy of ischemia-related heart failure via myocardial revascularization (stent / bypass surgery) and valve reconstruction are such options for treatment.
Other therapy options include defibrillators (implantable cardioverters / defibrillators, ICD) to prevent sudden heart death as well as biventricular pacemakers for cardiac resynchronization therapy (CRT).
In the case of advanced heart failure as per NYHA classes III-IV, it is recommended than an indication for implantation of an assist device be reviewed. This indication is in place for patients who demonstrate advancing heart failure despite exhaustion of all pharmacologic support. In most cases, VAD treatment serves to bridge the time until a heart transplantation. Depending on the underlying disease, however, myocardial function may also recover. As a result, explantation of the ventricular assist device may be possible.
Among patients for whom a heart transplantation is not an option, however, the long-term use of a ventricular assist device as part of permanent therapy is of increasing importance.